While the competitive bidding train rolls toward contract awards and implementation, big questions still loom. How will patients be affected? Because the winning bids are based on the lowest price, the beneficiary will be at risk for decreased quality of care. Competitive bidding will certainly decrease access to innovative technology that may have a higher price. Lost in the whole equation is the fact that home care remains the most cost-effective setting for care, as well as the setting most preferred by patients.

Another fundamental question is whether the program will achieve the savings that CMS has estimated. I am concerned that the Medicare administrative costs are not figured into any saving estimates. Competitive bidding could actually cost taxpayers more than the program would save.

AAHomecare has been working to get some clarity on a long list of issues to reduce confusion and help providers get ready for bidding since the time frame for bid submission is tight.

The rollout of the program will also continue to have political implications. On Capitol Hill, the home care community has a significant bill that would fix some of the big problems in competitive bidding. The Medicare Durable Medical Equipment Access Act of 2007 (HR 1845) was introduced in March by Representatives John Tanner (D-Tenn), David Hobson (R-Ohio), and Mike Ross (D-Ark). The bill would permit all qualified home care providers to continue to participate in Medicare at the selected award price, restore administrative and judicial review, and require CMS to demonstrate savings of at least 10% before implementing the bid for the product, among other key provisions.

But will this bill pass? The answer is simple: It depends on you. Will every provider in the United States pick up the phone or visit their member of Congress to explain the issue and lobby for the bill? Will providers get their patients and families involved? The lobbying efforts in Washington can make a big difference, but they will not succeed if home care providers back in their congressional districts stay on the sidelines.

Readers can listen to Tom Ryan’s comments via audio file here.

Competitive bidding will be hard on many home care providers, especially some of the smaller companies, which is why AAHomecare has worked so hard in recent years to ease the burden on small providers. The key is to get accredited now. Know your costs of providing the activities related to the provision of these products. The 30% target set aside in the final rule for small providers will be helpful, as will the ability for these small providers to form networks to participate.

In the long term, I think home care has a positive future. Demand will only grow. I hope that the industry will grow in its numbers, its credibility, and its success in the years ahead, and keep a large proportion of family-owned businesses that provide the kind of personal, quality care that have made them treasures to their local communities.

Tom Ryan is president of Homecare Concepts, Farmingdale, NY, and serves as chairman of AAHomecare.